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off the balance sheet: the impact of the economic crisis on girls and young women – a review of the evidence
Effects of crises on infant mortality Research has also found that mortality rates are higher among children born to younger and less-educated women, and women who live in rural areas.44 45 46 Most importantly, research confirms that girls are far more vulnerable than boys. A study of previous crises in 59 developing countries revealed that a 1 per cent fall in per capita GDP increases average infant mortality by 7.4 deaths per 1,000 births for girls compared with 1.5 deaths per 1,000 births for boys.47 Moreover, life expectancy falls by seven years for girls and six years for boys during periods of economic contraction, but increases by two years for both sexes during periods of economic growth.48 In some countries, such as India, macroeconomic crises appear to significantly increase the mortality rate for girls in rural areas, while boys are less likely to face increased mortality risks.49
Effects of crises on maternal mortality Although research is limited, economic crises also appear to contribute to an increase in maternal mortality rates. Using data from 14 high- and middle-income countries, one study estimated50 that a 10 per cent reduction in the GDP of the seven countries with the lowest income was associated with an 8.5 per cent increase in their maternal mortality rate. Evidence suggests that when a crisis leads to reductions in public health spending, income and food consumption, the knock-on effects of inadequate nutrition and health care make an already difficult situation worse, particularly for poor women and girls. In the mid-1990s an analysis of DHS data from 55 countries found that women in the richest quintile were 5.2 times more likely to deliver with medically trained staff than the poorest quintile.51 During economic downturns the number of women giving birth at home increases, while their nutritional status and the number of ante-natal and post-natal check-ups decline.52 For example, in Peru during the late 1980s economic crisis, pregnant women attended fewer antenatal check-
ups and were more likely to give birth at home.53 And during the 1997-1999 Asian financial crisis, the number of antenatal and postnatal check-ups in Indonesia declined, while unattended births increased from 1.6 per cent to 7.1 per cent.54 Although evidence is very limited, pregnant young women aged 15-19 in developing countries are likely to be even more vulnerable to the negative impact of a crisis that exacerbates already disturbing realities: an estimated half of all girls suffer from anaemia and face double the risk of dying during childbirth compared with older women, with complications of pregnancy and childbirth being the leading cause of death in sub-Saharan Africa and South Asia among girls of this age.55 However, concrete data on the impact of the recent global economic crisis on mortality rates (particularly in the second phase, post-2010) are still unavailable, and much of the evidence is anecdotal. Although it appears that maternal mortality has continued to fall, significant regional disparities persist and MDG 5, which aims to reduce the maternal mortality rate by three-quarters, is very unlikely to be achieved by 2015.56 Moreover, as many countries have focused spending cuts on health, education and social welfare – areas that disproportionately affect the poorest women and children – the impacts of these measures are likely to be severe.
Effects of crises on nutritional well-being According to the most recent data from the Food and Agriculture Organization of the United Nations (FAO), 850 million people – 15.5 per cent of the world’s population – are undernourished.58 Given that poor households spend a larger share of their income on food, it has been estimated that the 2007-2008 food price crisis pushed 105 million people into poverty in low-income countries.59 The second food-price crisis, in 20102011, pushed a further 44 million people into poverty in low- and middle-income countries.60